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SECTOR-WIDE APPROACHESIN THE HEALTH SECTOR

(IN UGANDA)

KEY CHARACTERISTICS

&

CHALLENGES

Dr. Martinus Desmet,

MPN, WHO Country Office - Uganda

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Content

Common definitions of SWApWhat SWAp really is (should be)ChallengesBelgian contribution to SWAp

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1. COMMON DEFINITIONS

- from policy to policy

- a process

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SWAp’s - DEFINITIONS“All significant funding for the sector supports:

- a single sector policy and expenditure programme

- government leadership

- adopting common approaches across the sector

- progress towards relying on government procedures to disburse and account for all funds.”

WHO (2000) “Sector-wide Approaches for Health Development”

SWAp = a process:-broadening & deapening policy dialogue

- more sector funds into co-ordinated arrangements

- developing common procedures based on those of government

------> focus on the intended direction of change

rather than just the level of attainment

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2. WHAT SWAp REALLY IS(or should be)

- not only funding

- efficiency / effectiveness

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ULTIMATE GOAL OF AHealth SWAp ?

“NOT ONLY A PROCESS”

ULTIMATE PURPOSE ?

INCREASE EFFICIENCY =

INCREASED AND IMPROVED OUTPUT

AT THE SAME COST

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So: What are the keys in aHealth SWAp to increase efficiency ?

GOVT USE PARTNERSHIP FORCONSENSUS BUILDING AROUND:

1) “SOLID PIECE” of POLICY- Evidence-based; based on ORGANISATIONAL PRINCIPLES for SERVICE DELIVERY

2) Common PLANNING devices- activity packages by level; 5-yr/1yr, incl. COSTING & FINANCING

3) ‘Adapted’ FUNDING arrangements (not only ‘common basket’)

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Health SWAp keys for increased efficiency (Cont’d)

4) Reliable MONITORING- on input, process & output

5) Continuous EVALUATION mechanisms- at “Health District” & national level; regular meetings with all involved

6) Accountable resources MANAGEMENT & ACCOUNTING procedures.

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3.CHALLENGES

- Donors & Govt

- Link with national budget frame & PRSP/PRSC

- Decentralisation

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1) GOVT & DONORS

GOVERNMENT POLICY, STRUCTURES & SYSTEMS NOT YET FULLY IN PLACE ACCOUNTABILITY ! LINKS WITH BROADER GOVT POLICIES, GOVT BUDGET PROCESS

DONORS RELUCTANT TO GO INTO BUDGET SUPPORT

(funding is not the only point) ‘MANAGERS’ MORE THAN HEALTH PROFESSIONALS

DONORS + GOVERNMENT NEW CONCEPT, NEEDS INTERNALIZATION TOO MUCH ‘PROCESS-ORIENTED’ AT NATIONAL (DISTRICT ?) LEVEL NO KNOWLEDGE OF DONOR DEPENDENCY RATIO

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2) LINK WITH NATIONAL BUDGET FRAME & PRSP/PRSC

TRENDS IN HEALTH FINANCING MECHANISMS PROJECT VS SECTOR SUPPORT; OTHER SOURCES ? OVER TIME: ‘REMAINING’ % OF TOTAL BUDGET FROM PROJECTS ‘EXTRA-BUDGETARY’ / FUNDS UNACCOUNTED FOR.

TENSION ‘SECTOR’ - ‘TOTAL’ GOVT BUDGET TOTAL GOVT BUDGET = OWN RESOURCES + HIPC I/II + OVERALL BUDGET

SUPPORT + SECTOR-SPECIFIC BUDGET SUPPORT BUDGET ALLOCATION PROCESS: PARTICIPATORY GOVT / CIVIL SOC / DONORS /

PARLIAMENT FUNGIBILITY OF DONOR FUNDS/ ROLE NATIONAL BANK DONOR DEPENDENCY RATIO ???

ESTABLISHMENT ‘POVERTY ACTION FUND’ = SPECIFIC ACTIVITIES IN DEFINED SECTORS FUNDED BY HIPC RETURNS + SPECIFIC DONOR CONTRIBITIONS (fungibility !).

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2) LINK WITH NATIONAL BUDGET FRAME & PEAP PRSP/PRSC (2)

IMPACT GLOBAL INITIATIVES NON-ADDITIONAL TO SECTOR BUDGET CEILING / “DISRUPTIVE” EXCHANGED AGAINST LESS TIGHT BUDGET COMPONENTS

SWAp STRUCTURES: Mid-Term Review, Health Policy Advisory Committee, Health Development

Partners Group

NEED FOR CLOSE COLLABORATION BETWEEN TECHNICAL EXPERTISE, AND ‘POLITICAL/ DIPLOMATIC’ LEVELS OF

REPRESENTATION’ OF DONOR COUNTRY E.g. Presidential proposal for budget cuts so as to cover extra-

ordinary defense expenditure. / Presidential proposal to increase with 25% the No. Of districts.

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2) LINK WITH NATIONAL BUDGET FRAME & PEAP PRSP/PRSC (3)

PEAP / PRSP VERY BROAD ! Macro-economic; Governance; Income of the Poor; Quality of Life of the Poor Poor vs Non-poor ?

FROM NATIONAL PLAN ----> PRSP ----> PRSC HEALTH SECTOR WITHIN “PILAR 4” OF POVERTY ERADICATION ACTION PLAN

(“PEAP”) PEAP = PRSP PRSP AS THE BASIS FOR PRSC.

OUTCOME OF HEALTH SWAp in PRSC PROCESS HSSP TARGETS AND MTR ‘UNDERTAKINGS’ USED AS BENCHMARKS IN THE

POLICY MATRIX OF PRSC TO MONITOR PROGRESS MADE

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4. CONTRIBUTION OF BELGIUM ?

- NATIONAL

- DISTRICT

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Contribution of BelgiumNational level

GOAL ?? (linked to sectors in Country Strategy Paper, Indicative Country Programme)

Participation in SWAp structures (HAPC, HDP group, MTR, Working Groups, ICCs): WHO ? HOW ?

Participation in PRSC process ? WHO ? HOW ?

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Contribution of Belgium (2)District level

GOAL ??In district coordination structures (esp.

When decentralised governments) WHO ? HOW ?

In operational activities. WHO ? HOW ?

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THANK YOU